By: Janice Lawrence Malone, MSN, RN, MBA

Black Americans are dying at alarming rates from COVID-19. Although Black Americans are minorities in the United States, they bear a higher burden of COVID-19 deaths. Several factors including chronic health and socioeconomic conditions, and healthcare disparities impact the toll of COVID-19 on Black Americans.

Chronic Health Conditions

Many, such as scientists, healthcare providers, and epidemiologists, rightfully point to conditions that make Black Americans more susceptible to COVID-19. These conditions include higher percentage of individuals of African ancestry with health conditions such as asthma, diabetes, hypertension and cardiac disease than whites (Huffpost). Evidence shows that individuals with pre-existing conditions are more likely to die from COVID-19 than those who are generally healthy.

Socioeconomic Conditions

In addition to chronic health conditions, socioeconomic conditions make Black Americans more vulnerable to the devastating effects of COVID-19. These socioeconomic conditions include poverty, lower wages, higher rates of unemployment, lower rate of health insurance, and limited access to adequate housing (The New Yorker). Furthermore, a large percentage of Black Americans are employed in industries such as public transportation  or food production (The Guardian) that do not allow individuals  to work from home. The inability to work from home increases the vulnerability of Black Americans contracting and dying from COVID-19.

Healthcare Disparities

Socioeconomic and chronic health conditions are factors that increase the vulnerability of Black Americans in contracting COVID-19. However, prior to the coming of COVID-19, disparities in healthcare have negatively impacted Black Americans. While some may choose to gloss over the facts regarding the increased vulnerability of Black Americans to COVID-19, and others blame Black Americans for not taking proper care of their health,  a closer look at the delivery of healthcare in the US shows that disparities in healthcare exist and the receipt of healthcare is often affected by the race of the person.

Disparities in health and the delivery of healthcare occur when  certain groups, whether due to socioeconomic conditions or race, receive different quality of  healthcare, and experience different health outcomes (KFF).  A report published almost 20 years ago by the Institute of Medicine (IOM), now known as the National Academy of Medicine (NAM), shows that American minorities receive worse healthcare than whites. Further, even when education, income, access to health insurance, and health conditions are similar, Black Americans are more likely to receive substandard healthcare than whites. Some examples of substandard care delivered to minorities, such as Black Americans, include earlier hospital discharge, and the use of cheaper treatments and medical interventions for conditions such as, but not limited to cardiac disease (ABA).

Healthcare disparities are also evident when communities with higher percentage of minorities and individuals with lower income levels are less likely to get COVID-19 testing than communities with a larger percentage of non-minorities and higher income levels, as well as delay in granting release to individuals incarcerated in prisons  with COVID-19 outbreaks (The New Yorker).

The alarming impact of COVID-19 on Black Americans is also influenced by race.

Looking Forward

The combination of chronic health issues, socioeconomic conditions such as unemployment and poverty, and healthcare disparities have combined over time to create a toxic environment wherein Black Americans are at greater risk of poor health outcomes and quality of life, and lower life expectancy. The coming of  COVID-19 has simply illuminated, over a shorter period of time, the impact of these conditions on Black Americans. In looking forward, some long-term solutions could be implemented to improve the health outcomes and quality of life for Black Americans. These solutions could include:

1. 1. Requirement that healthcare universities and colleges include education of healthcare disparities into their curriculum in order for future healthcare providers to become aware of the detrimental impact that racism could have on health outcomes.
   2. Active participation by Black Americans in managing chronic health conditions.
   3. Additional partnerships and community mentor programs that offer education and grant opportunities for Black Americans to secure higher education, or certification in trade occupations that offer better salaries and benefits.
   4. Increased participation of Black Americans in the election process as well as securing elected office in state and federal governments.
   5. Improved safety nets such as initiating personal savings or increasing personal savings, and access to affordable insurance such as the Affordable Care Act (ACA), also known as Obama Care. As noted by AMA President Dr. Patricia Harris, access to Obama Care could provide a substantial safety net for individuals and families (The Mercury News).

Recognition of the underlying causes of poor health outcomes of Black Americans is the first step in finding long term solutions.  However, workable solutions require collaboration between stakeholders including individuals and families, community organizations, and elected officials of state and federal governments.